Dental services for uninsured will suffer from hospital funding cut

Retiring from a 29-year-career at FedEx and giving up his health and dental insurance left Harold Davis with a bad taste in his mouth.

That distaste turned to pain when Davis’ teeth began to betray him. The 66-year-old Marine Corps veteran from Gastonia sought assistance at Gaston Family Health Services, which provides one of the few available dental care options for the uninsured.

“I just thank God they’ve got a place like this where a regular working man can come down and get help,” Davis said Wednesday, before an examination to determine his need for dentures.

Inadequate funding and a dependence on Medicaid patients was already severely limiting how many uninsured patients the dental clinic could help. But beginning in February, it will serve even less of them, due to a severe cutback in support from CaroMont Health and its flagship facility, Gaston Memorial Hospital.

A $480,000-a-year supplement from the hospital has been eliminated.

“It just gets worse for uninsured patients,” said Dr. William Donigan, the GFHS dental director. “As hard as it was to get in, it’s going to be even harder now.”

The hospital’s decision to cut the funding is based partly on higher costs it is facing due to federal health care reform, said Penny Cowden, CaroMont’s vice president of marketing and communications. It’s also tied to a dispute between CaroMont executives and Gaston County commissioners, who want the nonprofit hospital to provide more money each year in lieu of taxes.

Gaston Family Health Services was one of the largest recipients each year of funds that were donated through the CaroMont Health Foundation. But money was also disbursed to other agencies in need, such as the Gaston County Health Department.

The bulk of that funding is now a thing of the past.

“When we look forward, we have a lot of unknowns,” said Cowden. “We have financial pressure and we need to focus on funding our own needs first.”

Funding cut

GFHS was formed in 1991 to build on the services of the county health department and provide family health care – regardless of ability to pay. It receives $525,000 a year from the county tax base, but largely depends on grants to fund its $12 million Gaston County budget.

For 21 years, like clockwork, it received $40,000 a month – or $480,000 annually – from the CaroMont Health Foundation, said GFHS Director Robert Spencer.

In October, CaroMont issued a statement to the organizations that had traditionally applied for foundation funding. It clarified that the foundation was changing and would no longer be giving out grants or benevolent support for nonprofits.

“They did a complete 180 with the purpose of their foundation,” Spencer said.

Spencer said he heard at the time that because GFHS’ work is supportive of CaroMont’s mission, some other operational revenues might become available. But by December, he was told by CaroMont CEO Randall Kelley that wouldn’t be the case.

Page 2 of 3 - The key reason given, said Spencer, was the hospital’s ongoing financial disagreement with Gaston County commissioners.

“The last word I heard from them was they weren’t saying no, but they weren’t funding anything until these negotiations with the county were worked out,” said Spencer. “Now I’ve got a $500,000 hole in my budget I’ve got to figure out how to fill.

“We’ve been forced to make some tough decisions.”

Financial uncertainties

CaroMont formerly transferred 10 percent of its net profit each year to its hospital foundation. That money went to grants for internal departments and community groups, Cowden said.

Eighteen organizations applied for $2.3 million in donations last year. On average, the foundation awarded about $1.3 million a year in grants, she said.

Reforms being instituted through the federal health care mandate prompted CaroMont to rethink its generosity.

“The decision was made to stop transferring money to the foundation, and to have it serve as a fundraising foundation,” said Cowden. “We just don’t have the capital to meet those needs anymore.”

Sponsorships from the hospital marketing department will continue to be given out, though in much smaller amounts, she said.

The decision was also driven by the funding disagreement between county commissioners and hospital leaders, Cowden said.

“That is definitely playing a role in it,” she said.”

CaroMont has 22 years remaining on a contract that involves it leasing the hospital building and land from the county for $1 a year. Because CaroMont pays only minimal taxes here, county commissioners want it to contribute more annual money in lieu of taxes, to help fund other county needs.

CaroMont counters that its public, nonprofit status requires it to reinvest revenue in the community, and that it already contributes more than $100 million a year here to absorb bad debt and provide charity care.

Commissioners have exerted political pressure of late by appointing new members to the hospital’s board of directors.

Cowden said the county has suggested it wants anywhere from $2.5 million to $7 million a year in lieu of taxes, which paints an unpredictable picture for CaroMont.

“We’ve got to be careful, because we still have to fund our own capital needs,” she said.

Windows closing

The lost $480,000 will prompt a number of cost-cutting measures at GFHS.

Employees there will no longer receive Veterans Day as a holiday. Lab services will be contracted out to a cheaper provider.

Other changes will involve cuts to patient care.

Emergency departments have long been a haven for the uninsured, whether or not they truly need immediate medical aid. For years, such patients who showed up at Gaston Memorial have been referred to a primary care provider at GFHS.

Page 3 of 3 - “We provided a system where they could appoint patients into our clinic,” said Spencer. “We are now doing away with that system because we can’t afford to maintain it.”

The dental clinic, which typically pulls and fills teeth, engages in a Medicaid-driven balancing act. Only about 30 percent of patients seen there are completely uninsured. The clinic must maintain a certain percentage of Medicaid patients in order to fund services for everyone, officials say.

“I used to see four to five patients a day who were uninsured, out of a dozen or so total,” said Donigan, the dental director. “We’re having to cut that in half.”

Competition for the uninsured slots is fierce, and weekly appointments are filled in no time. People calling for appointments often become frustrated by busy dial tones and the small window of opportunity.

Most uninsured patients will now have to be funneled into a program that requires them to pay $75 per tooth procedure, Donigan said.

Davis, the uninsured veteran, is one of the lucky ones. But he feels for those who won’t be so fortunate.

“I think they do a wonderful job,” he said of the clinic workers. “Without this place, there’d be a lot of people who couldn’t afford dental or anything.”

You can reach Michael Barrett at 704-869-1826 or twitter.com/GazetteMike.